GOP delegate has proposal for health coverage for the poor

Dave Ress

A senior House of Delegates Republican is working on a unique-to-Virginia proposal to expand health care coverage for low-income Virginians that he hopes will break the standoff over Medicaid expansion.

Del. Thomas Rust, R-Herndon, plans to offer legislation for a complicated package of ways to tap Affordable Care Act dollars to expand coverage that are linked to key reforms fellow Republicans have demanded for Medicaid, the taxpayer-funded health insurance coverage for the poor and disabled.

"I keep coming back to: We're paying close to $2 billion a year right now and we're getting virtually none of it back," Rust said, referring to the several new taxes and fees imposed by the Affordable Care Act. That money was meant largely to fund the federal government's promise to pay for an expansion of Medicaid to cover all Americans with incomes less than 138 percent of the federal poverty line.

The current Medicaid system splits the cost equally between the federal government and Virginia. Though Virginia's share now accounts for the fastest-growing part of its budget, the state also has some of the strictest limits in the nation on who can get Medicaid. For example, parents who earn more than 30 percent of the federal poverty line, or $4,720 for a single parent with one child, make too much to get Medicaid here.

Rust's plan breaks new ground with a proposal that the state use Affordable Care Act funds to help working Virginians with incomes below the poverty line pay for their share of employer-provided health insurance. No other state has proposed this, he said.

Many of the state's lowest-wage workers or part-time workers can't afford the contribution that most employer plans require, he said. Roughly 70 percent of uninsured Virginians living below the poverty line fall into that bind, he said.

This program helps low-income people pay for commercial health insurance coverage if a member of their household is enrolled in Medicaid.

Rust's idea is to use the existing mechanism, funded by recouping Affordable Care Act dollars, to provide the same kind of help to Virginians living below the poverty line who don't already live with someone receiving Medicaid.

His proposal also envisions using Affordable Care Act funds to help a group of Virginians whose household incomes fall between 100 percent and 138 percent of the federal poverty line. In states like Virginia that have opted out of expanding Medicaid, this group is entitled to a federal subsidy to buy coverage through the Affordable Care Act's insurance exchanges.

But for someone with an income just above the federal poverty line — $11,670 for one person – even with a $2,600-plus-a-year federal subsidy, premium payments can be a stretch that keeps them from being able to afford coverage.

Rust said he hopes to address fellow Republicans' concerns over expanding Medicaid with language making clear that if Washington reneges on its promise to fund expansion, the additional coverage would end.

With the federal debt now standing at more than $17.7 trillion, Rust said he understands why many in his caucus are concerned that Washington might be tempted to shift more of the cost of any expansion to the states. The Affordable Care Act says the federal government will pay the entire cost until 2017. After that, the states are to pick up a gradually increasing share that will be capped at 10 percent by 2022.

Rust's bill will also propose major reforms to rein in the cost of Medicaid, including concrete steps he believes can be put in place within two years. His approach is in line with a joint legislative panel's 2-year-old mandate to reform Medicaid.

That mandate calls for a Medicaid system with networks of doctors and hospitals as tightly limited as commercial plans, managed care for mental health treatment and long-term care – the fastest growing and costliest-per-patient parts of the system – and requirements like those of commercial plans that recipients share costs and participate in wellness programs.

Rust said he plans to start circulating his proposal among fellow legislators within the next couple of weeks, looking for feedback and for suggestions for improvements.

"I know it isn't going to be easy," he said.

"This is too big and complicated to be considered as part of a budget," he said. "We need to take a separate, hard look at the issue."

Speaker of the House William J. Howell, R-Stafford, said he's committed to a full debate on expanding coverage in September, noting that he's made that point ever since announcing his intention to call the special session.

He said proponents of expansion can offer any proposal for consideration, and each proposal will be studied on its merits.

Howell did not comment specifically on Rust's proposal.

Del. Monty Mason, D-Williamsburg, says expanding coverage would be a particular boost for his district, since so many people working for tourism businesses make do by juggling multiple part-time jobs. He said he's excited to see what Rust proposes.

"I hope this is an indication that some Republicans now understand the financial consequences of failing to close the coverage gap," said House Minority Leader David Toscano.

"Virginia taxpayers have lost over $1 billion since January because of the House's failure to act. Iit is time to get this money returned to the commonwealth so it can help our citizens."